Abstract Rationale Illness severity at time of initial sepsis presentation to medical care is a major driver of patient outcomes. Social determinants of health may influence patients’ sepsis pre-hospital trajectory, including the timing of ED presentation. Using national area deprivation index (ADI), a scientifically validated measure of socioeconomic disadvantage, we investigated the association of socioeconomic status with illness severity at time of presentation among ED patients with sepsis. Methods We performed a secondary analysis of a pragmatic clinical trial enrolling all ED patients meeting sepsis criteria at three hospitals in Utah from November 2019 to February 2021. Patients who left the ED AMA or without treatment, patients without ADI data, and repeat sepsis encounters by individual patients were excluded from the analysis. Patients were stratified into approximately equal quartiles according to their national ADI scores. The primary exposure was national ADI quartile; the primary outcome was acute organ failure severity measured by change in Sequential Organ Failure Assessment (SOFA) score from baseline. Additional outcomes included ICU admission, in-hospital mortality, and 30-day mortality. Associations of the exposure and outcomes were evaluated with linear or logistic regression, adjusted a priori for age, sex, race, preferred language English, marital status, and Charlson Comorbidity Index. Results Among 10,106 patients, those with worse socioeconomic deprivation were more likely to be female, identify as non-white, have a preferred language other than English, and be single. In unadjusted analysis, acute increases in SOFA scores were similar as ADI worsened from quartile 1 3.15 (1.62) through quartile 4 3.20 (1.69). After adjustment, there was no statistically or clinically significant trend in the extent to which SOFA scores increased from baseline. For each 1 step worsening in ADI quartile, the estimated increase in SOFA from baseline was +0.03 points (95% CI 0.00-0.06, p = 0.05). Similarly, adjusted analyses for secondary outcomes of ICU admission, in-hospital mortality, and 30-day mortality did not demonstrate any significant trend in outcomes across ADI quartiles. Conclusions Sepsis patients present to the ED with similar illness severity regardless of socioeconomic status as measured by national ADI. After adjustment for confounders, neither the point estimate nor the 95% confidence interval suggests a clinically important association of ADI with illness severity on presentation with sepsis. In the context of prior research suggesting differences in presentation illness severity associated with patients’ insurance type, these data suggest that other specific social factors, but not global socioeconomic deprivation, may influence ED presentation behavior. This abstract is funded by: NIGMS (R35GM151147), Intermountain Research and Medical Foundation
Murnin et al. (Fri,) studied this question.